Side Effects in Multimodal Treatment Concepts in Carcinomas of the Head and Neck

2001 ◽  
pp. 185-190 ◽  
Author(s):  
B.M. Lippert ◽  
A.A. D�nne ◽  
J.A. Werner
Keyword(s):  
Side Effects ◽  
Head And Neck ◽  
Multimodal Treatment ◽  
Treatment Concepts

scholarly journals Synergies Radiotherapy-Immunotherapy in Head and Neck Cancers. A New Concept for Radiotherapy Target Volumes-“Immunological Dose Painting”

Medicina ◽  
2020 ◽  
Vol 57 (1) ◽  
pp. 6
Author(s):  
Camil Ciprian Mireştean ◽  
Anda Crişan ◽  
Călin Buzea ◽  
Roxana Irina Iancu ◽  
DragoşPetru Teodor Iancu
Keyword(s):  
Immune System ◽  
Synergistic Effect ◽  
Head And Neck ◽  
Multimodal Treatment ◽  
Clinical Target Volume ◽  
Locally Advanced ◽  
Target Volume ◽  
Head And Neck Cancers ◽  
Dose Painting ◽  
Target Volumes

The combination of immune checkpoint inhibitors and definitive radiotherapy is investigated for the multimodal treatment of cisplatin non-eligible locally advanced head and neck cancers (HNC). In the case of recurrent and metastatic HNC, immunotherapy has shown benefit over the EXTREME protocol, being already considered the standard treatment. One of the biggest challenges of multimodal treatment is to establish the optimal therapy sequence so that the synergistic effect is maximal. Thus, superior results were obtained for the administration of anti-CTLA4 immunotherapy followed by hypofractionated radiotherapy, but the anti-PD-L1 therapy demonstrates the maximum potential of radio-sensitization of the tumor in case of concurrent administration. The synergistic effect of radiotherapy–immunotherapy (RT–IT) has been demonstrated in clinical practice, with an overall response rate of about 18% for HNC. Given the demonstrated potential of radiotherapy to activate the immune system through already known mechanisms, it is necessary to identify biomarkers that direct the “nonresponders” of immunotherapy towards a synergistic RT–IT stimulation strategy. Stimulation of the immune system by irradiation can convert “nonresponder” to “responder”. With the development of modern techniques, re-irradiation is becoming an increasingly common option for patients who have previously been treated with higher doses of radiation. In this context, radiotherapy in combination with immunotherapy, both in the advanced local stage and in recurrent/metastatic of HNC radiotherapy, could evolve from the “first level” of knowledge (i.e., ballistic precision, dose conformity and homogeneity) to “level two” of “biological dose painting” (in which the concept of tumor heterogeneity and radio-resistance supports the need for doses escalation based on biological criteria), and finally to the “third level“ ofthe new concept of “immunological dose painting”. The peculiarity of this concept is that the radiotherapy target volumes and tumoricidal dose can be completely reevaluated, taking into account the immune-modulatory effect of irradiation. In this case, the tumor target volume can include even the tumor microenvironment or a partial volume of the primary tumor or metastasis, not all the gross and microscopic disease. Tumoricidal biologically equivalent dose (BED) may be completely different from the currently estimated values, radiotherapy treating the tumor in this case indirectly by boosting the immune response. Thus, the clinical target volume (CTV) can be replaced with a new immunological-clinical target volume (ICTV) for patients who benefit from the RT–IT association (Image 1).

Rhinological, laryngological, oropharyngeal and other head and neck side effects of drugs

2006 ◽  
Vol 120 (2) ◽  
pp. 1-10 ◽  
Author(s):  
C A Lee ◽  
D Mistry ◽  
R Sharma ◽  
A P Coatesworth
Keyword(s):  
Hearing Loss ◽  
Drug Therapy ◽  
Side Effects ◽  
Head And Neck ◽  
British National Formulary ◽  
National Formulary ◽  
Drug Side Effects

Following a previous paper in which we documented the otological side effects of drug therapy, we here review other drug side effects that ENT surgeons may encounter when dealing with patients. Although otological drug side effects such as hearing loss and tinnitus are well recognized there are many rhinological, laryngeal, oropharyngeal and other head and neck drug side effects. Our data were sourced from the British National Formulary and Electronic Medical Compendium websites.

scholarly journals En-Bloc Irradiation of Tumours of the Head and Neck and Their Lymphatics: II. Early results and side effects

1978 ◽  
Vol 17 (3) ◽  
pp. 189-198 ◽  
Author(s):  
T. Andersson ◽  
A. Biörklund ◽  
T. Landberg ◽  
C. Mercke ◽  
G. Svahn-tapper
Keyword(s):  
Side Effects ◽  
Head And Neck ◽  
En Bloc ◽  
Early Results

Polichemotherapy of Advanced Head and Neck Malignancies

1976 ◽  
Vol 62 (6) ◽  
pp. 599-607 ◽  
Author(s):  
Massimo Fazio ◽  
Pietro Cavallero ◽  
Ezio Minetto ◽  
Pier Giorgio Rattalino ◽  
Silvio Sartoris
Keyword(s):  
Central Nervous System ◽  
Squamous Cell Carcinoma ◽  
Nervous System ◽  
Side Effects ◽  
Head And Neck ◽  
Advanced Head ◽  
Head And Neck Malignancies ◽  
The Central Nervous System ◽  
Previously Treated ◽  
Total Remission

The favorable results obtained by other authors with polichemotherapy encouraged us to employ therapeutic scheme using a combination of 4 drugs. Treatment envolved the administration of 300 mg/m2 cyclophosphamide, 350 mg/m2 5-fluorouracil, 10 mg/m2 methotrexate i.v. on alternate days 6–8 times, and 15 mg bleomycin on alternate days until a total dose of 150–200 mg is reached. Thirty-five out of 37 patients treated with this protocol (30 previously treated and 5 not) qualified for analysis; the site of the neoplasm, mostly squamous cell carcinoma, was different; for the most part it was in the larynx (18/35) and the oral cavity (10/35). Complete remission was achieved in 9/35 patients (25.7%), varying from 5 to 33 months (median 22); partial remission was achieved in 15/35 cases (42.8%), varying from 1 to 14 months (median 3); and there was no success in 11/35 cases (31.5%). Overall, a total remission > 50 % was observed in 24/35 patients (68.5 %). The most serious side effects both ascribed to BLM were observed in the central nervous system (increasing drowsiness and coma) and the lung. This study has shown that in the ultra head and neck malignancies medical treatment can achieve satisfactory results.

The EORTC randomized trial on three fractions per day and misonidazole (trial no. 22811) in advanced head and neck cancer: long-term results and side effects

1995 ◽  
Vol 35 (2) ◽  
pp. 91-99 ◽  
Author(s):  
Walter Van den Bogaert ◽  
Emmanuel van der Schueren ◽  
Jean-Claude Horiot ◽  
Mario De Vilhena ◽  
Simon Schraub ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Side Effects ◽  
Randomized Trial ◽  
Head And Neck ◽  
Neck Cancer ◽  
Long Term Results ◽  
Advanced Head

scholarly journals Nanoparticle-Based Chemotherapy Formulations for Head and Neck Cancer: A Systematic Review and Perspectives

Nanomaterials ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 1938
Author(s):  
Jefferson Muniz de Lima ◽  
Paulo Rogerio Bonan ◽  
Danyel Elias da Cruz Perez ◽  
Michael Hier ◽  
Moulay A. Alaoui-Jamali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck Cancer ◽  
Side Effects ◽  
Head And Neck ◽  
Neck Cancer ◽  
Meta Analysis ◽  
Basic Research ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Mortality And Morbidity

Head and neck cancer (HNC) is a complex and heterogeneous disease associated with high mortality and morbidity worldwide. Standard therapeutic management of advanced HNC, which is based on radiotherapy often combined with chemotherapy, has been hampered by severe long-term side effects. To overcome these side effects, tumor-selective nanoparticles have been exploited as a potential drug delivery system to improve HNC therapy. A combination of MEDLINE, EMBASE, Cochrane Oral Health Group’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov from inception up to June 2020 was used for this systematic review. A total of 1747 published manuscripts were reviewed and nine relevant references were retrieved for analysis, while eight of them were eligible for meta-analysis. Based on these studies, the level of evidence about the efficacy of nanoformulation for HNC therapy on tumor response and adverse side effects (SAE) was low. Even though basic research studies have revealed a greater promise of nanomaterial to improve the outcome of cancer therapy, none of them were translated into clinical benefits for HNC patients. This systematic review summarized and discussed the recent progress in the development of targeted nanoparticle approaches for HNC management, and open-up new avenues for future perspectives.

Experience with cetuximab plus paclitaxel/carboplatinum in primary platinum-resistant recurrent head and neck cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6077-6077 ◽  
Author(s):  
J. Buentzel ◽  
A. de Vries ◽  
O. Micke
Keyword(s):  
Head And Neck Cancer ◽  
Side Effects ◽  
Head And Neck ◽  
Neck Cancer ◽  
Egf Receptor ◽  
Therapeutic Option ◽  
Therapeutic Benefit ◽  
Platinum Resistance ◽  
Platinum Resistant ◽  
Recurrent Head

6077 Background: In patients with platinum-resistant recurrent head and neck cancer the Anti-EGF-receptor antibody cetuximab could be used as a treatment option. Little is known about results of this therapeutic option. The objective of this study was to evaluate therapeutic benefit of this indication. Methods: 23 patients with histological confirmed recurrent head and neck cancer (18 male, 3 female, median age was 57 years) were included in this exploratory study. All recurrences had occurred after chemotherapy with platinum- derivates. 19 patients received radiation therapy during primary treatment. No surgical or radiotherapeutic option in recurrent disease was possible. Two patients were diagnosed with lung metastasis. The 2nd-line therapy consisted of carboplatinum (200 mg/m2) + paclitaxel (200 mg/m2) every three weeks (week 1, 4, and 7) and additionally cetuximab, which was given with 400 mg/m2 as loading dose in week 1 and 250 mg/m2 in week 2–6. Results: A significant tumor response was observed in 13/23 patients (56%). 7 partial, 5 minor and one complete remission were registered. The median survival time was 8 month (range 3–10), 4 patients are still alive. Median time to progression was 5 month (range 2–8). Side effects were rash (16/22), fever (9/22) and typical chemotherapy induced toxicities as neuropathy (7/22) and cytopenia (4/22). All side effects were moderate and easy to handle. Conclusions: The described combined chemoimmuntherapy with cetuximab and paclitaxel + carboplatinum seems to offer new strategies in 2nd and 3rd line chemotherapy for patients with platinum-resistant head and neck cancer, potentially overcoming primary platinum resistance. No significant financial relationships to disclose.

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